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Q & A on the Affordable Care Act for AI/AN

Question: Do patients have to do anything related to the Affordable Care Act on October 1?

Answer:  October 1 is when enrollment begins for the state and federal Marketplaces and for some States that choose to expand Medicaid.  Since the Marketplace coverage doesn’t take effect until Jan. 1st and open enrollment lasts until the end of March 2014, immediate action on October 1 is not needed.  In addition, members of federally-recognized tribes can enroll monthly even after March so there is no rush for our patients to take action. However, IHS needs to be ready to answer patient questions by October 1.

Question:  Do all Indian Health Service (HIS) patients have to enroll in the State or Federal Marketplaces and buy insurance?

Answer:  No. If individuals are already covered by private insurance through their job or family, Medicare, Medicaid, CHIP, or other types of health coverage, they are considered to have met the mandate (requirement) to maintain insurance coverage so they don’t have to enroll in the Marketplace.  That applies to around 70% of our IHS patients who are already covered by private insurance, Medicare, Medicaid, CHIP, etc. 

For IHS eligible patients, if they do not have health coverage (which is about 30 percent of our patients), they can keep using IHS and apply for a hardship waiver (or qualify for the exemption in the law if they are a member of a federally recognized tribe) in order to avoid the minimum responsibility payment for not maintaining minimum coverage.  Documentation for those that receive the hardship waiver or exemption will first be needed when individuals file their 2014 taxes (by the deadline of April 2015). 

Or, they may now be eligible to purchase insurance coverage or qualify for Medicaid. There are many ways the ACA makes coverage more affordable for American Indian and Alaska Native individuals including premium tax credits assistance and cost sharing waivers (based on their income level or being a member of a federally recognized tribe). 

That's why we want all our patients to at least apply to see if they are required to have health coverage and to see what types of benefits for which they may be eligible.  And those that want to use the hardship waiver because they don’t have other coverage will need to apply for it anyway through the Marketplaces.  So everyone should check